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CAT in One Session

Goldzweig, J., 2000. CAT in One Session. Reformulation, ACAT News Summer, p.x.

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The patient was in the waiting room having seen the doctor and hoping to see me as an emergency.

Tom was an overweight greying 55-year-old. During the weekend he broke down sobbing and seemingly overwhelmed with grief. His wife took him to the A & E at the Royal Free hospital. After a three-hour wait he saw a doctor who gave him medication for sleeping and told him to see his GP. The doctor at my surgery offered medication which would take a few weeks to kick in and - or counselling. He chose counselling.

The Case

Tom had not been able to sleep for the past two weeks and had often had been overcome with uncontrollable weeping. He cannot stop thinking about his business. He owns a fleet of taxis with a partner who looks after the accounts. They owe a great deal of money to a garage for servicing the fleet. Tom feels that his partner is running the business down in order to buy him out at a good price. Tom sees the business as something to hold on to for his pension. He has seen his accountants and the business is not in too bad a shape but he just can’t get it out of his mind.

He knows that it’s irrational but it has got a grip on him and will not let go, no matter how much he tries to think of something else. I asked if he had any other obsessions, I went through a few examples, to which he said no. I then checked if there was any history of similar experiences, he said no. He was trying to hide his need to weep and did burst out crying when worrying about upsetting his wife. I now felt the need to reassure him and say anything that I could to lower the level of anxiety.

I said that I had seen people with a similar condition before and that it could take from a few weeks to a few months to recover completely. (As it had with three other similar cases that I had seen) And that anyway, over time, he would recover with or without the help of the doctor or me. Naming the illness or condition and reassuring him that he would recover soon clearly lowered his anxiety level to such an extent that we had time for some therapy; in this case the crucial element of CAT, a reformulation. Mainly, Tom felt cheated and let down by a friend and partner and thought that his pension was in jeopardy. He also felt a failure and that he was letting his family down.

When the feelings were recognised and expressed in words they seemed manageable and panic receded. I suggested that perhaps as a way of coping when threatened with loss, failure and disappointment he obsessively focuses on one issue such as others are trying to control or cheat him leading to being overcome with fear and panic. Something that he recognised immediately and further putting him at ease. Because of my earlier experience in treating this kind of patient with a doctor I advised him to consider medication as well as counselling. (On reflection I did not believe the transformation taking place in front of me) I arranged to see him in four days time and asked him to wait in reception while I had a word with the doctor about a medication for him.

At our next meeting he appeared relaxed and confident. His first words were "after you said that I was simply obsessed with this thought everything changed". He said that he went to see the garage people to explain the situation and they were very reasonable and made a settlement that they could all live with. He then went round to the accountants with his partner and worked out an agreement to close the business. Tom gets a taxi and his son out at Heathrow gets his own taxi both without any debt. His partner gets the rest of the fleet but has to sort out the debt. Although appearing calm he was clearly beside himself with joy saying that he has all that he wants for the future.

I was particularly pleased with this case because the patient found his own solutions and completed the process (revision) using his own resources without recourse to medication and any more than necessary of doctor and counsellor.

When I asked him why he didn’t take the medication he said it was because he goes bell ringing on Wednesdays and looks forward to a pint afterwards and doctor warned him - no alcohol.

Jack was a counsellor for Relate for seven years and then started C.A.T training in 1990. After completing basic training (eight cases) he had two periods with Tony Ryle on his borderline research project. He works as an NHS counsellor at two GP surgeries in London.

Jack Goldzweig

Full Reference

Goldzweig, J., 2000. CAT in One Session. Reformulation, ACAT News Summer, p.x.

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